OBJECTIVE: Chimeric antigen receptor (CAR) T cell therapies have demonstrated good clinical responses in populations that have historically been difficult to treat; however, they are associated with potentially severe adverse events, including CRS and NEs. An economic model was created to estimate total weighted costs of CRS and NEs for 2L treatment of transplant-eligible relapsed/refractory large B-cell non-Hodgkin lymphoma treated with liso-cel and axi-cel based on rates reported in the TRANSFORM (NCT03575351) and ZUMA-7 (NCT03391466) studies.

METHODS: A decision tree economic model was developed using CRS and NE rates from TRANSFORM and ZUMA-7 to estimate costs from a health care system perspective in 2021 United States dollars. Cost estimate inputs were based on a micro-costing analysis of TRANSFORM, and the model assumed that cost inputs of CRS or NE management would not differ across therapies. A probabilistic sensitivity analysis was conducted using Monte Carlo simulation methods to address uncertainty surrounding the costs of key inputs. A scenario analysis was also conducted to assess CRS and NE costs for each CAR T cell therapy from a commercial payer perspective.

RESULTS: The overall per-patient weighted average cost for CRS and NEs was $3951 (liso-cel) and $15,084 (axi-cel). Per-patient weighted average cost per CRS event was $1850 (liso-cel) and $4857 (axi-cel). Per-patient weighted average cost per NE was $2101 (liso-cel) and $10,228 (axi-cel). In the commercial payer perspective scenario analysis, overall per-patient weighted average cost was $5621 (liso-cel) and $21,529 (axi-cel).

CONCLUSIONS: Reductions in estimated per-patient average cost for CRS and NEs with liso-cel compared with axi-cel, owing to lower CRS and NE rates, were $3007 and $8127 respectively, per the economic model; total estimated difference in average cost was $11,133 (74% lower with liso-cel). These lower estimated average costs highlight the economic importance of differentiated safety profiles between CAR T cell therapies.